Tracy E Madsen1, Mehrnoosh Samaei2, Aleksandra Pikula3, Amy Y X Yu4, Cheryl Carcel5, Erika Millsaps6, Ria Sara Yalamanchili7, Nicole Bencie8, Adrienne N Dula9, Michelle Leppert10, Tatjana Rundek11, Rachel P Dreyer12, Cheryl Bushnell13. 1. Department of Emergency Medicine, Warren Alpert Medical School, and the Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island. Electronic address: Tracy_Madsen@brown.edu. 2. Department of Emergency Medicine, Division of Sex and Gender in Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island. 3. Department of Medicine (Neurology), University of Toronto, University Health Networks, Toronto, Ontario, Canada. 4. Department of Medicine (Neurology), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. 5. The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia. 6. Reid Health, Richmond, Indiana. 7. Pacific Northwest University of Health Sciences, Yakima, Washington. 8. Warren Alpert Medical School, Brown University, Providence, Rhode Island. 9. Departments of Neurology and Diagnostic Medicine, Dell Medical School, University of Texas, Austin, Texas. 10. Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado. 11. Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida. 12. Center for Outcomes Research and Evaluation, Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut. 13. Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Abstract
PURPOSE: Physical inactivity, a modifiable risk factor for cardiovascular disease, is independently associated with stroke. Though some prior data have suggested sex differences in levels of physical activity, whether there are sex differences in the role of physical activity in primary stroke prevention is largely unknown. This systematic review identifies and describes recent findings on sex differences in the association between physical activity and incident (first-ever) stroke. This review also describes the current evidence on the strength of the association between physical activity and a reduced stroke risk in women in particular. METHODS: Using a prespecified strategy, PubMed/MEDLINE and Cochrane Central were searched to identify observational studies or trials published from 2000 to 2020 and reporting sex differences in physical activity and incident stroke. To be included, among other criteria, studies had to include sex-specific effect estimates from women, men, or both. Titles, abstracts, and full-text articles were screened to identify studies meeting the inclusion criteria, and adjusted sex-specific estimates of the association between physical activity and incident stroke for total stroke (ischemic plus hemorrhagic) or ischemic stroke were abstracted. FINDINGS: Thirty-seven studies met the inclusion criteria. Of 17 studies that included data on total incident stroke (ischemic and hemorrhagic combined) in both women and men, 7 (41%) showed similar associations between physical activity and incident stroke between women and men, 6 (35%) suggested a significant effect in women but not in men, and 3 (18%) showed a significant effect in men but not in women. Of 10 studies that included data on ischemic stroke in women and men, 5 (50%) suggested similar effects in women and men, 4 (40%) suggested a significant effect in women but not in men, and 1 (10%) showed an effect in men but not women. In women specifically, the majority of included studies demonstrated a reduced risk for incident stroke with physical activity, with relative risk reductions ranging from 11% to 72%, though most estimates fell between 20% and 40%. IMPLICATIONS: The majority of studies indicated a clear association between physical activity and a reduction in stroke risk. Studies were split as to the potential for sex differences in this association. Future prospective investigations should identify strategies for the use of increased physical activity for primary stroke prevention, with sex-specific considerations as warranted. The data on sex-specific dose-response relationship between physical activity and stroke risk are inconclusive and warrant more research.
PURPOSE: Physical inactivity, a modifiable risk factor for cardiovascular disease, is independently associated with stroke. Though some prior data have suggested sex differences in levels of physical activity, whether there are sex differences in the role of physical activity in primary stroke prevention is largely unknown. This systematic review identifies and describes recent findings on sex differences in the association between physical activity and incident (first-ever) stroke. This review also describes the current evidence on the strength of the association between physical activity and a reduced stroke risk in women in particular. METHODS: Using a prespecified strategy, PubMed/MEDLINE and Cochrane Central were searched to identify observational studies or trials published from 2000 to 2020 and reporting sex differences in physical activity and incident stroke. To be included, among other criteria, studies had to include sex-specific effect estimates from women, men, or both. Titles, abstracts, and full-text articles were screened to identify studies meeting the inclusion criteria, and adjusted sex-specific estimates of the association between physical activity and incident stroke for total stroke (ischemic plus hemorrhagic) or ischemic stroke were abstracted. FINDINGS: Thirty-seven studies met the inclusion criteria. Of 17 studies that included data on total incident stroke (ischemic and hemorrhagic combined) in both women and men, 7 (41%) showed similar associations between physical activity and incident stroke between women and men, 6 (35%) suggested a significant effect in women but not in men, and 3 (18%) showed a significant effect in men but not in women. Of 10 studies that included data on ischemic stroke in women and men, 5 (50%) suggested similar effects in women and men, 4 (40%) suggested a significant effect in women but not in men, and 1 (10%) showed an effect in men but not women. In women specifically, the majority of included studies demonstrated a reduced risk for incident stroke with physical activity, with relative risk reductions ranging from 11% to 72%, though most estimates fell between 20% and 40%. IMPLICATIONS: The majority of studies indicated a clear association between physical activity and a reduction in stroke risk. Studies were split as to the potential for sex differences in this association. Future prospective investigations should identify strategies for the use of increased physical activity for primary stroke prevention, with sex-specific considerations as warranted. The data on sex-specific dose-response relationship between physical activity and stroke risk are inconclusive and warrant more research.
Authors: Lynda D Lisabeth; Mathew J Reeves; Jonggyu Baek; Lesli E Skolarus; Devin L Brown; Darin B Zahuranec; Melinda A Smith; Lewis B Morgenstern Journal: Stroke Date: 2015-01-29 Impact factor: 7.914
Authors: Clinton Hall; Julia E Heck; Dale P Sandler; Beate Ritz; Honglei Chen; Niklas Krause Journal: Scand J Work Environ Health Date: 2018-11-19 Impact factor: 5.024